Bone positioning and cutting system and method

ABSTRACT

A method of performing a bunion surgery to correct an alignment between a first metatarsal and a first cuneiform may involve aligning a bone cutting guide with a joint between the first metatarsal and the first cuneiform. The bone cutting guide can have a joint plate offset from a guide feature, with the joint plate extending downwardly relative to the guide feature. The process of aligning the bone cutting guide with the joint may involve inserting the joint plate into the joint. The method may involve using the guide feature of the bone cutting guide to guide a cutting tool to cut a leading edge of the first metatarsal and adjusting an alignment of the first metatarsal relative to the first cuneiform using a bone positioning device. The method may also involve fixing a position of the first metatarsal relative to the first cuneiform with a bone connector.

RELATED APPLICATIONS

This application is a continuation application of U.S. patentapplication Ser. No. 16/730,424, filed Dec. 30, 2019, which is acontinuation application of U.S. patent application Ser. No. 15/894,702,filed Feb. 12, 2018, issued as U.S. Pat. No. 10,555,757, on Feb. 11,2020, which is a divisional application of U.S. patent application Ser.No. 14/799,981, filed Jul. 15, 2015, which claims priority to U.S.Provisional Application No. 62/024,546, filed Jul. 15, 2014. The entirecontents of each of these applications are hereby incorporated byreference.

TECHNICAL FIELD

This disclosure generally relates to devices and methods for positioningand cutting bones.

BACKGROUND

In various surgical procedures, it can be necessary to cut one or morebones. Success of such surgical procedures may often times be a functionof the accuracy of the cut(s) being made to the one or more bones.Accomplishing accurate cuts can be especially complicated where surgicalprocedures involve cutting one or more bones that are relatively smallas compared to bones in other locations of a surgical patient's anatomy.Exemplary surgical procedures involving cuts to one or more relativelysmall bones can include surgical procedures involving a foot or hand. Tohelp facilitate accurate cuts to one or more bones, it may be useful toposition the one or more bones to be cut in a manner that is conduciveto a particular cut.

SUMMARY

One embodiment includes a bone positioning device. The embodiment of thebone positioning device can include at least one fixation pin forattachment to a first bone and at least one fixation pin for attachmentto a second bone. A first block having at least one aperture can beincluded for slidably receiving a fixation pin(s), and a second blockhaving at least one aperture can be included for slidably receiving afixation pin(s). A multi-axis joint can connect the first block and thesecond block, where the multi-axis joint allows the first and secondblocks to move with respect to each other about more than one axis.

Another embodiment includes a method for fixing an orientation of afirst bone with respect to a second bone. The embodiment of the methodcan include attaching at least one fixation pin to a first bone andattaching at least one fixation pin to a second bone. At least onefixation pin can be inserted within a respective aperture of a firstblock, and at least one fixation pin can be inserted within a respectiveaperture of a second block. The first block can be positioned along andabout the fixation pin(s) and a set screw(s) can be actuated to fix aposition of the first block along and about the fixation pin(s), andsimilarly the second block can be positioned along and about thefixation pin(s) and a set screw(s) can be actuated to fix a position ofthe second block along and about the fixation pin(s). The position ofthe first block can be adjusted with respect to the second block aboutat least a first axis and a second axis. A set screw can be actuated tofix a position about the first axis, and a set screw can be actuated tofix a position about the second axis.

A further embodiment includes a bone cutting guide. The embodiment ofthe bone cutting guide can include a plate defining a plane, a blockhaving a guiding surface integral with or coupled to the plate, with theguiding surface being parallel to the plane and being spaced laterallytherefrom. A handle can also be included extending from the plate.

BRIEF DESCRIPTION OF THE DRAWINGS

The following drawings are illustrative of particular embodiments of thepresent invention and therefore do not limit the scope of the invention.The drawings are not necessarily to scale (unless so stated) and areintended for use in conjunction with the explanations in the followingdetailed description. Embodiments of the invention will hereinafter bedescribed in conjunction with the appended drawings, wherein likenumerals denote like elements.

FIG. 1 is a perspective view of a bone positioning device according toan embodiment of the invention;

FIG. 2 is a top plan view of the bone positioning device of FIG. 1;

FIG. 3 is a side plan view of the bone positioning device of FIG. 1;

FIG. 4 is a perspective cross-sectional view of the bone positioningdevice of FIG. 1;

FIG. 5 is a perspective view of a bone positioning device attached tobones in a skewed position according to an embodiment of the invention;

FIG. 6 is a top view of the bone positioning device of FIG. 5;

FIG. 7 is a side view of the bone positioning device of FIG. 5;

FIG. 8 is a side view of the bone positioning device of FIG. 5;

FIG. 9 is a perspective view of a bone cutting guide according to anembodiment of the invention;

FIG. 10 is a perspective view of a bone cutting guide according to anembodiment of the invention in contact with a saw blade; and

FIG. 11 is a side plan view of the bone cutting guide and saw blade ofFIG. 10.

DETAILED DESCRIPTION

The following detailed description is exemplary in nature and is notintended to limit the scope, applicability, or configuration of theinvention in any way. Rather, the following description provides somepractical illustrations for implementing exemplary embodiments of thepresent invention. Examples of constructions, materials, dimensions, andmanufacturing processes are provided for selected elements, and allother elements employ that which is known to those of ordinary skill inthe field of the invention. Those skilled in the art will recognize thatmany of the noted examples have a variety of suitable alternatives.

Embodiments of the invention include a bone positioning device.Embodiments of the bone positioning device can be useful for temporarilyfixing bones in a desired position during a surgical procedure, such asa bone alignment, osteotomy, and/or fusion procedure. Such a proceduremay be performed, for example, on bones (e.g., adjacent bones separatedby a joint or different portions of a single bone) in the foot or hand.In one example, the procedure can be performed to correct an alignmentbetween a metatarsal (e.g. a first metatarsal) and a cuneiform (e.g., afirst cuneiform), such as a bunion correction. An example of such aprocedure is a Lapidus procedure. In another example, the procedure canbe performed by modifying an alignment of a metatarsal (e.g. a firstmetatarsal). An example of such a procedure is a Basilar metatarsalosteotomy procedure.

As shown in FIGS. 1-4, the bone positioning device 10 can include atleast one fixation pin, such as a first fixation pin 20, for attachmentto a first bone 24. At least one fixation pin, such as a second fixationpin 30, can be provided for attachment to a second bone 34, such as anadjacent bone separated by a joint or different portions of a singlebone. As shown best in FIG. 4, a first block 40 having a first aperture50 can slidably receive the first fixation pin 20, and a second block 60having a second aperture 70 can slidably receive the second fixation pin30. The first and second apertures 50, 70 can allow the first and secondblocks 40, 60 to slide along a longitudinal axis of the first and secondfixation pins 20, 30, respectively. The first and second apertures 50,70 can also allow the first and second blocks 40, 60 to rotate about thelongitudinal axis of the first and second fixation pins 20, 30,respectively. In some embodiments, each of the first and second fixationpins 20, 30 are generally cylindrical and have a distal portion and aproximal portion, with the distal portion threaded for retention withinthe respective first or second bone, while the proximal portion isunthreaded for both sliding within the respective first or secondaperture and free rotational movement within the respective first orsecond aperture. In some embodiments, the proximal portion has a uniformdiameter, such that it does not contain a flared or “head” portion. Insuch embodiments, the first and second blocks can be positioned on thefirst and second fixation pins before or after the pins are engaged withbone.

Again as shown best in FIG. 4, a multi-axis joint 80 can be provided toconnect the first block 40 and the second block 60 and located adjacentto a joint 84 between the first and second bones. In some embodiments,the multi-axis joint 80 allows the first block 40 and the second block60 to move with respect to each other about more than one axis. Incertain embodiments, the multi-axis joint 80 allows the first block 40and the second block 60 to move with respect to each other about thethree cardinal planes (i.e., X, Y, and Z axes). In the embodiment shown,the multi-axis joint 80 allows for angulation in all directions androtation between the first and second blocks. FIGS. 5-8 depict anexemplary embodiment of the bone positioning device 10 attached to firstand second bones 24, 34, where the first and second bones are skewedrelative to each other. In this particular embodiment, a longitudinalaxis of second bone 34 is skewed about 15 degrees relative to alongitudinal axis of first bone 24.

The multi-axis joint can include any suitable structure for allowingdesired adjustments about more than one axis, such as desiredadjustments about three axes. In some embodiments, with reference toFIG. 4, the multi-axis joint 80 includes a link 90 having a first end 94rotatably connected to the first block 40 and a second end 98 rotatablyconnected to the second block 60. Such a multi-axis joint allows for themovement about the various axes discussed above at both the first endand the second end. In the embodiment shown, the first end 94 includes afirst ball received within a first socket of the first block 40, and thesecond end 98 includes a second ball received within a second socket ofthe second block 60.

Some embodiments of the device allow the relative positions of the firstand second bones to be fixed after a desired orientation has beenachieved. For example, a first set screw 100 can extend through thefirst block 40 into the first aperture 50 and be positioned against thefirst fixation pin 20, for fixation of the first block on a longitudinalaxis of the first fixation pin and/or about the longitudinal axis of thefirst fixation pin. Further, a second set screw 110 can extend throughthe second block 60 into the second aperture 70 and be positionedagainst the second fixation pin 30, for fixation of the second block ona longitudinal axis of the second fixation pin and/or about thelongitudinal axis of the second fixation pin. In certain embodiments,the first and second set screws are positioned perpendicular to thefirst and second fixation pins. As shown in FIGS. 1-3, additional setscrews 120, 130 extending through the first and second blocks can bepositioned opposite of the first and second set screws, respectively.Such oppositely positioned set screws may facilitate use of the bonepositioning device on a left foot or a right foot depending on aparticular surgical procedure.

Set screws can also be provided to fix positions across the multi-axisjoint. In the embodiment shown in FIG. 4, a first end set screw 140extends through the first block 40 and is positioned against the firstend 94 of the link 90. Further, a second end set screw 150 is shownextending through the second block 60 and positioned against the secondend 98 of the link 90.

The set screws can include any structure suitable to fix the relativepositions of the components described herein. In some embodiments, theset screws have a threaded connection with the blocks. Further, asshown, they can include a recess with a non-circular surface. Such arecess is useful for engagement with a driving tool, such as ahex-driver.

In some embodiments, the device can be used to apply a compression forcebetween two adjacent bones, or different portions of a single bone,while the bones are held in desired alignment and/or to facilitate adesired alignment between the bones. Such a compression force is usefulfor certain surgical procedures, such as bone fusions. As shown in FIG.4, in some embodiments the device 10 includes a compression screw 160operable to exert a compression force between first and second bones 24,34 connected to first and second fixation pins 20, 30, respectively. Inthe embodiment shown, the compression screw 160 is generallyperpendicular to the fixation pins and is threadingly received within ablock and positioned to act against one of the fixation pins.

One of the blocks can be adapted to allow for relative movement to exertthe compression force. In the embodiment shown in FIG. 4, one of theblocks (e.g., the first block 40) has a first portion 170 slidinglyconnected to second portion 180. An aperture (e.g., the first aperture50) extends through the first portion and the second portion. In thisembodiment, the first aperture has a first cross-sectional area in thefirst portion and a second cross-sectional area in the second portion,and the first cross-sectional area is smaller than the secondcross-sectional area. The set screw 100 can extend through the firstportion 170. The compression screw 160 can extend through the secondportion 180. Upon actuation, the compression screw 160 will act againstthe fixation pin 20 and will pull the second portion 180 of the block 40away from the fixation pin 20. The force will be transmitted through themulti-axis joint 80 through the other block 60 and fixation pin 30,thereby applying a compression force that tends to press togetherleading surfaces (e.g., interfacing surfaces) of the first and secondbones 24, 34.

Some embodiments include a bone cutting guide. Such a guide can beuseful for guiding the cutting of bone, such as after a position of thebone has been fixed by the device described above. Bone cutting may beuseful, for example, to facilitate contact between leading edges ofadjacent bones or different portions of a single bone, such as in a bonealignment and/or fusion procedure.

An embodiment of a bone cutting guide is shown in FIGS. 9-11. In theembodiment shown, the guide 200 includes a plate 210 that defines aplane, a block 230, and a handle 240 extending from the block 230. Asshown, the handle extends from the block 230 at an angle of between 30and 60 degrees (e.g., 45 degrees) with respect to the plane. The plate210 can include a top edge, a bottom edge opposite of the top edge, andfirst and second opposite side surfaces. In the embodiment shown in FIG.9, the block 230 can include a surface 250 parallel to the plate 210 andoffset from the plate by a distance (e.g., 1-20 millimeters). As shownin FIGS. 10 and 11, a cutting tool 260, such as a saw blade, may beplaced in apposition to the surface 250 to guide cutting in a planeparallel to the plate and offset from it by a distance (e.g., a distancethe surface 250 if offset from the plate 210).

In use, the bottom edge of the plate 210 can be placed such that itextends into a joint space or resected portion between the first bone 24and a second bone 34. The surface 250 can provide a cutting tool guidesurface operable to guide a cutting tool to cut a leading edge of a bonein a plane parallel to the plate 210.

Embodiments of the invention also include methods of temporarily fixingthe orientation of a first bone with respect to a second bone, such asduring a surgical procedure, using a bone positioning device. In someembodiments, the method includes a step of attaching a first fixationpin slidably and rotatingly received within a first aperture of a firstblock to a first bone and attaching a second fixation pin slidably androtatingly received within a second aperture of a second block to asecond bone. The method can also include the steps of positioning thefirst block along the first fixation pin and actuating a first set screwto fix a position of the first block along the first fixation pin.Likewise, the method can include the steps of positioning the secondblock along the second fixation pin and actuating a second set screw tofix a position of the second block along the second fixation pin. Insome embodiments, the method can include the steps of adjusting theposition of the first block with respect to the second block about atleast a first axis and a second axis and actuating a third set screw tofix a position about the first axis and actuating a fourth set screw tofix a position about the second axis. In certain embodiments, the methodcan also include actuating a compression screw to apply a compressionforce between the first and second bones. It should be noted these stepsneed not be performed in the order stated, which is merely exemplary.For example, the second fixation pin may be attached to the second bonebefore the first fixation pin is attached to the first bone, bothfixation pins may be attached before either block is adjusted or fixed,etc.

The method may also include steps following the fixing of the positionof the bones. Some embodiments of the method also include imaging (e.g.,with an X-ray) the first and second bones connected to the first andsecond blocks to confirm a desirable alignment. Certain embodiments ofthe method include fusing the first bone and the second bone, such as byattaching a bone connector (e.g., a plate, pin, screw, wire, or staple)to stably connect and fix the first bone and the second bone. Someembodiments also include the step of removing the first fixation pinfrom the first bone and the second fixation pin from the second bone,such as at a time after the bones have been stabilized and connectedwith a bone connector.

Some embodiments of the method also include cutting a leading edge ofthe first or second bone using a cutting guide, such as by positioning acutting guide proximate the bone (e.g., within a joint between adjacentbones or a resected portion of a single bone) and using the guide to cuta leading edge of the bone in a plane. Such embodiments can also includethe step of actuating a compression screw to apply a compression forcebetween the first and second bones after the cutting step.

Thus, embodiments of the invention are disclosed. Although the presentinvention has been described with reference to certain disclosedembodiments, the disclosed embodiments are presented for purposes ofillustration and not limitation and other embodiments of the inventionare possible. One skilled in the art will appreciate that variouschanges, adaptations, and modifications may be made without departingfrom the spirit of the invention.

What is claimed is:
 1. A method of performing a bunion surgery tocorrect an alignment between a first metatarsal and a first cuneiform,the method comprising: aligning a bone cutting guide with a jointbetween a first metatarsal and a first cuneiform, the bone cutting guidecomprising a joint plate offset from a guide feature of the bone cuttingguide, the joint plate extending downwardly relative to the guidefeature, wherein aligning the bone cutting guide with the jointcomprises inserting the joint plate into the joint; using the guidefeature of the bone cutting guide to guide a cutting tool to cut aleading edge of the first metatarsal; adjusting an alignment of thefirst metatarsal relative to the first cuneiform using a bonepositioning device; compressing the first metatarsal and the firstcuneiform together by at least applying a force to press a firstfixation pin inserted into the first metatarsal and a second fixationpin inserted into the first cuneiform toward one another; and fixing aposition of the first metatarsal relative to the first cuneiform with abone connector.
 2. The method of claim 1, further comprising, prior tofixing the position of the first metatarsal relative to the firstcuneiform with the bone connector, temporarily fixing the position ofthe first metatarsal relative to the first cuneiform.
 3. The method ofclaim 1, wherein adjusting the alignment of the first metatarsalrelative to the first cuneiform using the bone positioning devicecomprises moving the first metatarsal in a plane defined by X- andY-axes.
 4. The method of claim 1, wherein the joint plate defines aplane, the guide feature defines a plane, and the plane defined by thejoint plate is parallel to the plane defined by the guide feature. 5.The method of claim 1, wherein the joint plate is offset from the guidefeature by being spaced laterally from the guide feature, and the guidefeature defines a guiding surface that is offset from the joint plate adistance ranging from 1 millimeter to 20 millimeters.
 6. The method ofclaim 1, wherein the joint plate is inserted into the joint and contactsthe leading edge of the first metatarsal.
 7. The method of claim 1,wherein the joint plate is inserted into the joint and contacts theleading edge of the first cuneiform.
 8. The method of claim 1, whereinjoint plate is integral with the guide feature.
 9. The method of claim1, wherein using the guide feature of the bone cutting guide to guidethe cutting tool comprises placing the cutting tool in apposition to aguide surface defined by the guide feature of the bone cutting guide.10. The method of claim 9, wherein the guide surface is operable toguide the cutting tool in a plane parallel to the guide surface.
 11. Themethod of claim 1, wherein using the guide feature of the bone cuttingguide to guide the cutting tool comprises placing the cutting tool incontact with a guide surface defined by the guide feature of the bonecutting guide.
 12. The method of claim 1, wherein the cutting tool is asaw blade.
 13. The method of claim 1, further comprising using the guidefeature of the bone cutting guide to guide the cutting tool to remove aleading edge of the first cuneiform.
 14. The method of claim 13, whereinremoving the leading edge of the first metatarsal and removing theleading edge of the first cuneiform promotes bone fusion.
 15. The methodof claim 1, wherein the bone connector is configured to promote fusionbetween the first metatarsal and the first cuneiform.
 16. The method ofclaim 1, wherein the bone connector comprises a plate.
 17. The method ofclaim 1, wherein the bone connector comprises a screw.
 18. The method ofclaim 1, wherein the bone connector comprises a pin.
 19. The method ofclaim 1, wherein the bone connector comprises a staple.
 20. The methodof claim 1, further comprising imaging the first metatarsal and thefirst cuneiform to evaluate the position of the first metatarsalrelative to the first cuneiform prior to fixing the position with thebone connector.
 21. The method of claim 20, wherein imaging the firstmetatarsal and the first cuneiform comprises taking an X-ray image ofthe first metatarsal and the first cuneiform.
 22. The method of claim 1,wherein using the guide feature of the bone cutting guide to guide thecutting tool to cut the leading edge of the first metatarsal comprisesusing the guide feature of the bone cutting guide to guide the cuttingtool to cut the leading edge of the first metatarsal after adjusting thealignment of the first metatarsal relative to the first cuneiform usingthe bone positioning device.
 23. The method of claim 1, wherein fixingthe position of the first metatarsal relative to the first cuneiform isperformed after the first metatarsal is moved to a corrected alignmentrelative to the first cuneiform.
 24. The method of claim 1, wherein theguide feature is spaced laterally from the joint plate, and furthercomprising: using the guide feature of the bone cutting guide to guidethe cutting tool to remove a leading edge of the first cuneiform, andcompressing the first metatarsal and the first cuneiform together by atleast applying a force to press a first fixation pin inserted into thefirst metatarsal and a second fixation pin inserted into the firstcuneiform toward one another.
 25. The method of claim 24, whereinremoving the leading edge of the first metatarsal and removing theleading edge of the first cuneiform promotes bone fusion, andcompressing the first metatarsal and the first cuneiform togethercomprises compressing the first metatarsal and the first cuneiformtogether after removing the leading edge of the first metatarsal and theleading edge of the first cuneiform.
 26. The method of claim 25, whereinadjusting the alignment of the first metatarsal relative to the firstcuneiform using the bone positioning device comprises moving the firstmetatarsal in a plane defined by X- and Y-axes, and further comprising,prior to fixing the position of the first metatarsal relative to thefirst cuneiform with the bone connector, temporarily fixing the positionof the first metatarsal relative to the first cuneiform.
 27. The methodof claim 24, wherein the bone connector comprises at least one of aplate, a screw, and a staple.